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1.
Indian J Pharmacol ; 53(4): 317-327, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34414911

RESUMO

Since the onset of COVID-19 pandemic, parallel opportunistic infections have also been emerging as another disease spectrum. Among all these opportunistic infection, mucormycosis has become a matter of concern with its rapid increase of cases with rapid spread as compared to pre-COVID-19 era. Cases have been reported in post-COVID-19-related immune suppression along with the presence of comorbidity which adds on the deadly outcome. There is no systematic review addressing the issue of COVID-19-associated mucormycosis. This is the first systematic review of published studies of mucormycosis associated with COVID-19. The aim was to analyze the real scenario of the disease statement including all the published studies from first November 2019 to 30th June to analyze the contemporary epidemiology, clinical manifestations, risk factor, prognosis, and treatment outcome of COVID-19 associated rhino-orbito-cerebral-mucormycosis. A comprehensive literature search was done in following databases, namely, PubMed, Google Scholar, Scopus, and EMBASE using keywords mucormycosis, rhino orbital cerebral mucormycosis, COVID-19, and SARS-CoV-2 (from November 01, 2019 to June 30, 2021). Our study shows that, while corticosteroids have proved to be lifesaving in severe to critical COVID-19 patients, its indiscriminate use has come with its price of rhino-orbito-cerebral mucormycosis epidemic, especially in India especially in patients with preexisting diabetes mellitus with higher mortality. Corticosteroid use should be monitored and all COVID-19 patients should be closely evaluated/monitored for sequelae of immunosuppression following treatment.


Assuntos
COVID-19/virologia , Coinfecção , Meningite Fúngica/microbiologia , Mucormicose/microbiologia , Doenças Nasais/microbiologia , Infecções Oportunistas/microbiologia , Doenças Orbitárias/microbiologia , SARS-CoV-2/patogenicidade , Antifúngicos/uso terapêutico , COVID-19/imunologia , COVID-19/mortalidade , Interações Hospedeiro-Patógeno , Humanos , Meningite Fúngica/tratamento farmacológico , Meningite Fúngica/imunologia , Meningite Fúngica/mortalidade , Mucormicose/tratamento farmacológico , Mucormicose/imunologia , Mucormicose/mortalidade , Doenças Nasais/tratamento farmacológico , Doenças Nasais/imunologia , Doenças Nasais/mortalidade , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/imunologia , Infecções Oportunistas/mortalidade , Doenças Orbitárias/tratamento farmacológico , Doenças Orbitárias/imunologia , Doenças Orbitárias/mortalidade , Prognóstico , Medição de Risco , Fatores de Risco , SARS-CoV-2/imunologia
2.
Indian J Pharmacol ; 53(6): 499-510, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34975140

RESUMO

BACKGROUND: Till now, no meta-analysis is available to address the clinical profile, risk factors, different interventions, and outcomes among COVID-19-associated rhino-orbito-cerebral mucormycosis (C-ROCM) cases. MATERIALS AND METHODS: Eight literature databases were screened using appropriate keywords from November 1, 2019, to June 30, 2021. The objectives were to analyze the clinical and microbiological profile, risk factor/comorbidity, intervention, and outcome. "R-metafor package" was used for analysis. RESULTS: A total of 23 studies were included. The mean age of presentation of C-ROCM was 54.6 years. The most common presentation was ptosis (72.7%), lid edema (60.6%), proptosis (60.6%), ophthalmoplegia (57.3%), loss of vision (53.7%), facial edema (34.7%), and nasal-blockage (11.8%). Evidence of intracranial spread was seen in 42.8% of cases. Rhizopus was the most common fungus (57.1%) isolated in fungal culture. Among C-ROCM patients, diabetes was the commonest comorbid condition, and the use of corticosteroids related to COVID-19 treatment was the most common risk factor (85.75%). Compared to controlled diabetics, C-ROCM was significantly higher among uncontrolled diabetics (odds ratio [OR] 0.15, 95% confidence interval [C.I.] 0.041-0.544, P = 0.0010). However, no significant association was seen between C-ROCM and COVID-19 severity (OR 0.930, 95% C.I. 0.212-4.087, P = 0.923). For treatment, amphotericin-B was the most common antifungal drug used which was followed by surgical options. However, mortality was high (prevalence 0.344, 95% C.I. 0.205-0.403) despite treatment. CONCLUSION: Although local rhino-orbito symptoms were the first to appear, rapid intracranial extension was seen in a significant number of C-ROCM cases. Uncontrolled diabetes and excessive use of corticosteroid were the most common risk factors present among the C-ROCM cases. High index clinical suspicion is imperative (specifically among COVID-19 patients with diabetes), and routine screening may be helpful.


Assuntos
Encefalopatias/complicações , COVID-19/complicações , Mucormicose/complicações , Doenças Nasais/complicações , Doenças Orbitárias/complicações , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Encefalopatias/tratamento farmacológico , COVID-19/virologia , Humanos , Mucormicose/tratamento farmacológico , Doenças Nasais/tratamento farmacológico , Doenças Orbitárias/tratamento farmacológico , Análise de Regressão , Fatores de Risco , SARS-CoV-2/isolamento & purificação
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